TY - JOUR
T1 - Oral anticoagulation in device-detected atrial fibrillation
T2 - effects of age, sex, cardiovascular comorbidities, and kidney function on outcomes in the NOAH-AFNET 6 trial
AU - Lip, Gregory Y H
AU - Nikorowitsch, Julius
AU - Sehner, Susanne
AU - Becher, Nina
AU - Bertaglia, Emanuele
AU - Blomström-Lundqvist, Carina
AU - Brandes, Axel
AU - Beuger, Vincent
AU - Calvert, Melanie
AU - Camm, Alan John
AU - Chlouverakis, Gregory
AU - Dan, Gheorghe-Andrei
AU - Dichtl, Wolfgang
AU - Diener, Hans Christoph
AU - Fierenz, Alexander
AU - Goette, Andreas
AU - de Groot, Joris R
AU - Hermans, Astrid
AU - Lubinski, Andrzej
AU - Marijon, Eloi
AU - Merkely, Bela
AU - Mont, Lluis
AU - Ozga, Ann-Kathrin
AU - Rajappan, Kim
AU - Sarkozy, Andreas
AU - Scherr, Daniel
AU - Schnabel, Renate
AU - Schotten, Ulrich
AU - Simantirakis, Emmanuel
AU - Toennis, Tobias
AU - Vardas, Panos
AU - Wichterle, Daniel
AU - Zapf, Antonia
AU - Kirchhof, Paulus
N1 - NOAH-AFNET 6 was partially funded by BMBF (German Ministry of Education and Research, Berlin, Germany) through the DZHK (German Center for Cardiovascular Research, Berlin, Germany, grant number FKZ 81X2800182) and by Daiichi Sankyo Europe. Further support was provided by European Union CATCH ME (grant agreement No 633196) to P.K. and U.S. and AFNET; AFFECT-EU (grant agreement 847770) to P.K.; MAESTRIA (grant agreement 965286) to A.G., P.K., U.S., and AFNET; British Heart Foundation (AA/18/2/34218) to P.K.; German Research Foundation (Ki 509167694) to P.K.; DZHK (grant numbers 81Z0710116 and 81Z0710110) to P.K., Leducq Foundation to P.K., and the Dutch Heart Foundation (EmbRACE, grant number 01-002-2022-0118) to U.S. U.S. received grants from Roche (to institution).
PY - 2024/4/9
Y1 - 2024/4/9
N2 - Implanted pacemakers, defibrillators, and loop recorders detect short and rare episodes of device-detected atrial fibrillation [DDAF, previously also called atrial high-rate episodes or subclinical atrial fibrillation (AF)] in ∼30% of patients. Device-detected atrial fibrillation rarely has therapeutic consequences in patients with ECG-documented AF. Device-detected atrial fibrillation without ECG-documented AF can lead to consideration of oral anticoagulation in clinical practice, especially in older patients with multiple stroke risk factors and/or very long DDAF episodes, largely based on observational data. Two recent controlled trials, NOAH-AFNET 6 and ARTESiA, observed a low rate of ischaemic stroke without anticoagulation (1.1%–1.2%/patient-year) in patients with DDAF and stroke risk factors, including in patients with very long DDAF episodes in NOAH-AFNET 6. Current guidelines leave the decision to anticoagulate to clinical judgement, balancing the expected stroke risk, typically estimated by using stroke risk scores developed in patients with ECG-documented AF, and the stroke risk reduction induced by anticoagulation, with the increase in bleeding associated with anticoagulation therapy.
AB - Implanted pacemakers, defibrillators, and loop recorders detect short and rare episodes of device-detected atrial fibrillation [DDAF, previously also called atrial high-rate episodes or subclinical atrial fibrillation (AF)] in ∼30% of patients. Device-detected atrial fibrillation rarely has therapeutic consequences in patients with ECG-documented AF. Device-detected atrial fibrillation without ECG-documented AF can lead to consideration of oral anticoagulation in clinical practice, especially in older patients with multiple stroke risk factors and/or very long DDAF episodes, largely based on observational data. Two recent controlled trials, NOAH-AFNET 6 and ARTESiA, observed a low rate of ischaemic stroke without anticoagulation (1.1%–1.2%/patient-year) in patients with DDAF and stroke risk factors, including in patients with very long DDAF episodes in NOAH-AFNET 6. Current guidelines leave the decision to anticoagulate to clinical judgement, balancing the expected stroke risk, typically estimated by using stroke risk scores developed in patients with ECG-documented AF, and the stroke risk reduction induced by anticoagulation, with the increase in bleeding associated with anticoagulation therapy.
U2 - 10.1093/eurheartj/ehae225
DO - 10.1093/eurheartj/ehae225
M3 - Letter
SN - 0195-668X
JO - European Heart Journal
JF - European Heart Journal
M1 - ehae225
ER -